Khoa hc hnh vi - T chc y t - Phng php hc ng dng

GII PHP KIM SOT CC THUC GY NGHIN, THUC HNG TM THN V THUC C BNG A,B
Dng Thy Mai (1) Ngi hng dn: Nguyn Th Thi Hng (2) Hong Th Minh Hin(3)

TM LC Hin nay, vic qun l thuc ti bnh vin v cc trung tm y t vn ang l mt thc trng tn ti ln. Hu ht vai tr ca khoa Dc trong qun l kinh ph hiu qu s dng thuc s dng ti bnh vin rt m nht, ch mang tnh cp pht hu cn. Thc t trnh chuyn mn cng nh trnh qun l yu km v vn thiu nhn lc xy ra vic lm dng thuc, s dng thuc khng thch hp iu tr ti cc khoa lm sng. Bn cnh s qun l lng lo cn gy ra tnh trng tht thot thuc v ngn sch. c bit vi cc thuc c, thuc gy nghin v thuc hng thn, tuy l cc thuc trong danh mc b qun l c bit song vn nm trong tnh trng chung l gn nh khng qun l c i hi phi cc nh qun l phi c bin php cp thit can thip kp thi. SUMMARY The management of drugs used in hospital is very problematic. In fact, the key role of pharmaceutical department in managing effect and budget of drugs using is insignificant, only as logistical dispensation. The lack of experience in professional knowledge and management lead to drugs abuse. Beside, bad management can cause loss of drug and money. Particulary with the narcotic,
1, 2,

sedative, and intoxycative A-B drugs, althought these are controlled drugs, they are uncontrolled too. Those problems require that managers have to built1 a thorough solution to intervene immediately. I. T VN Vic m bo hiu lc cng tc qun l v thc hin cc quy ch Dc ti bnh vin l mt trong nhng nhim v quan trng ca khoa Dc . Tuy nhin, theo bo co tng kt ca thanh tra Y t s 775/BC-TTr ngy 12/31/2004, mc d cc c s y t c kim tra c thc chp hnh quy nh, song vn cn mt s vn tn ti nh cha cp nht thuc vo s theo quy nh (42,8%)..... Ch th ca B Y t s 02/1999/CTBYT ngy 01/01/1999 v cng vn s 50 ca B Trng s 1054/YT-TTr n ngy 25/2/2005 nu r: Bnh vin v cc khoa iu tr cn c bin php qun l cht ch vic s dng cc thuc gy nghin, thuc hng tm thn nhm m bo n tay ngi bnh trnh tht thot gy hu qu xu c mt ci nhn thu o v vn ny, ngin cu can thip c tin hnh trn vic thc hin quy ch qun l thuc trong k n v lm h s bnh n vi hai mc ch sau 1. nh gi vic thc hin quy ch qun l thuc gy nghin, thuc hng thn v thuc c

SV Trng i hc Dc H Ni PGS TS Trng i hc Dc H Ni 3, Ths Bnh vin Hu Ngh

148

Hi Ngh Khoa Hc Cng Ngh Tui Tr Cc Trng i Hc Y Dc Vit Nam ln th XIII

bng A,B trong ghi n thuc v h s bnh n. 2. La chn mt gii php can thip nhm gim thiu sai phm trong vic thc hin quy ch. II. I TNG V PHNG PHP NGHIN CU 1. i tng: H s bnh n v n thuc ngoi tr c s dng thuc gy nghin thuc hng thn v thuc c bng A,B vi cc chuyn khoa tim mch, u bu,h hp c xng khp, thn kinh gic quan ti bnh vin Hu Ngh. 2. Phng php nghin cu : S dng phng php can thip xy dng v trin khai ti liu hng dn gip bc s thc hin ng quy ch trong k n. A. C mu :

C mu c tnh theo cng thc sau: P(1-P) N=Z2(1-/2) 2 d N : C mu . Z(1-/2) : Ph thuc vo h s tin cy (1-/2) , tra theo bng tnh sn. P : 0,5 (c mu ti a). d : Khong sai lch cho php, khng qu 5%. Vy c mu nghin cu l: 390 mu. Nghin cu tin hnh ly mu theo k thut chn mu ngu nhin.

3. Thi gian ly mu :
- Trc can thip: n thuc ngoi tr v h s bnh n t01/02/05 15/04/2005 - Sau can thip: n thuc ngoi tr v h s bnh n t 1/5/2005 1/6/2005

III. KT QU NGHIN CU V BN LUN 1. Kt qu kho st trc can thip. a. Ghi h s bnh n. Bng 1.1 Kt qu kho st vi phm trong vic thc hin quy nh nh s th t theo di i vi cc thuc b qun l. Chuyn khoa C mu S h s sai T l sai phm phm (%) Tim mch 60 53 88.3 U bu 60 43 71.7 C xng khp 60 55 90.0 H hp 60 55 91.7 Thn kinh 60 54 90.0 Tng 240 261 87 o T l sai phm trong vic thc hin quy ch l ng bo ng (87%) .c bit vi mt s thuc nh Diazepam vin 5mg ( 87%), Corticoid ( Dexamethansone vin 4mg, Tobradex nh mt). 149 o T l ny cho thy cc bc s khng nm r danh mc thuc thuc din qun l . iu ny c th dn ti vic lm dng thuc hng thn, thuc c.

Khoa hc hnh vi - T chc y t - Phng php hc ng dng

b. Ghi n thuc ngoi tr. Bng 1.2 : Sai phm trong ghi n thuc ngoi tr. STT Ni dung S n T l 1 Tng s n thuc ngoi tr 90 100% 2 Tng s n c sai phm 72 80% 3 Sai phm trong cch ghi s lng thuc 48 53,3% 4 Vi phm ngy k n ti a cho php 52 57,7% - Cc thuc thng b ko di ngy k n qu quy nh cho php l NITROMINT (glyceryl trinitrat)- vin 2.6 mg, GLYBURID vin 5mg, DIAZEPAM- vin 5mg. 2. Tin trnh thc hin nghin cu can thip Vi kt qu trn, C th rt ra kt lun rng vic thc hin quy ch qun l thuc vn cha c gii quuyt trit . V vy cn thit phi c mt gii php can thip tc thi. Tn ti chung - Khng nh s th t theo di. - Ghi s lng thuc khng theo ng cch quy nh. - K n vt qu s ngy ti a cho php. - K n qu liu ti a khng c ch k bn cnh.

Xc nh Nguynnhn

thuc b qun l. - Vic tra cu khng thun tin. - Khng nm r quy ch. - Khng qun th quy nh

- Khng thuc danh mc

Nguyn nhn

Trc can thip

La chn gii php can thip

Gii php chuyn mn

Sau can thip Xy dng ti liu hng dn vic thc thi quy ch

KIM SOT

Gii php hnh chnh

Tin trnh ngin cu can thip .

a. Gii php chuyn mn : Da vo nghin cu trn xy dng mt ti liu hng dn Danh mc thuc gy nghin, thuc hng thn, thuc c bng A,B s dng ti bnh vin Hu Ngh -2005 vi cc ni dung sau :

Phn 1

Trch cc quy nh qun l thuc gy nghin, thuc hng thn v thuc c bng A,B. 1. Cc hng dn c th cch ghi n 2. Mu n cho thuc thng v thuc gy nghin 150

Hi Ngh Khoa Hc Cng Ngh Tui Tr Cc Trng i Hc Y Dc Vit Nam ln th XIII

Danh mc thuc b qun l Gm trn 100 thuc tn dc c phn loi t danh mc thuc bnh vin 6 thng u nm 2005 Phn 3 Cc vn bn php quy lin quan dng xy dng ti liu Cc thuc trong danh mc c vit Cng b kt qu sai phm ang theo tn thng vi hm lng v dng bo ng. Gii thiu hng dn ti bo ch tng ng, mt s c tn bit liu h tr vic thc thi cc quy ch. Dc. Danh mc c sa i 6 thng Tin hnh p dng cho ton bnh mt ln theo danh mc thuc c du vin To introduce and instruct thu dng trong bnh vin. health-workers in morning meeting and to carry out in all departments of b. Gii php hnh chnh: hospital . Bo co, trnh ban gim c, Xy dng ch ti x pht theo Ch tch hi ng thuc v iu tr quy nh ca B Y t v ca bnh ph duyt . vin. 3. Kt qu can thip a. n thuc ni tr Bng 3.3 Sai phm trong ghi h s bnh n Chuyn khoa S mu T l(%) Trc can thip Sau can thip Tim mch 60 88.3 70 U bu 60 71.7 46.7 C xng khp 60 90.0 70.0 H hp 60 91.7 65.0 Thn kinh gic quan 60 90.0 73.3 Total 240 87 69.0 b. n thuc ngoi tr Bng 3.4 Sai phm trong n thuc ngoi tr. T l (%) STT Ni dung S mu Trc can Sau can thip thip 1 Tng s n kho st 90 100% 100% 2 Tng s n c sai phm 72 80 70 3 Sai phm trong cch ghi s lng 48 53,3 42 4 K n qu ngy ti a cho php 52 57,7 47 th ngn c vic ph phm thuc khng Vic kim sot cht ch s ngy k n ti cn thit a i vi n thuc ngoi tr l rt cn thit. Th nht, n thuc ngoi tr s ch ch c php 10 ngy thay cho 20 v 30 ngy nh trc y vic s dng thuc c theo di cht ch hn. Th hai,n c IV. KT LUN Nghin cu vic ghi n trc v sau can thip a ra cc kt lun sau: 1. T l sai phm l cao. Trong s , sai phm trong ghi h s bnh n l 151

Phn 2

Khoa hc hnh vi - T chc y t - Phng php hc ng dng

2.

3.

4.

5.

87% v trong n thuc ngoi tr l 80%. T l sai phm c bit cao cc thuc nh: DIAZEPAM tablet 5mg(87.34%), Dexamethasone tablet 4mg(85%), TOBRADEX eyes-drop (70%). Sai phm chnh trong n thuc ngoi tr l: sai phm trong cch ghi s lng thuc (55.3%). K n qu ngy ti a cho php (57,7%) thng xut hin vi cc thuc DIAZEPAM tablet 5mg, TRINITRO GLYCERIN tablet 2,6mg, GLYBURID tablet 5mg. Trong iu kin thi gian, ngn sch v ngun nhn lc hn ch gii php can thip trn c xem l gii php thch hp nht v c th nhanh chng mang li hiu qu qun l. Gii php ny gp phn gim thiu s lm dng thuc. c bit gip ngn chn s lng ph v s thiu kim sot khi n thuc ngoi tr b ko di qu ngy ti a cho php. Trong tng lai, vic thit lp mt tnh nng t ng qun l s s dng thuc trong h thng thng tin bnh vin l cn thit. Tnh nng t ng ny cn cnh bo c loi thuc b qun l khi chng c bc s k n trn my tnh.

3.

4.

5.

6.

7.

V.

Ti liu tham kho : 1. Q s 2033/1999/Q-BYT ngy 09/7/1999 ca B trng B Y t v vic ban hnh Quy ch qun l thuc gy nghin, danh mc thuc gy nghin v danh mc thuc gy nghin dng phi hp 2. Q s 1442/2002/Q-BYT ngy 25/04/2002 ca B trng B Y t v vic sa i b sung mt s iu

8.

9.

ca quy ch Qun l thuc gy nghin ban hnh km theo quyt nh s 2033/1999/Q-BYT ngy 09/7/1999 Q s 2032/1999/Q-BYT ngy 09/07/1999 ca B trng B Y t v vic ban hnh qui ch qun l thuc c, danh mc thuc c, danh mc thuc gim c Q s 3046/2001/Q-BYT ngy 12/07/2001 ca B trng B Y t v vic b sung danh mc thuc c v danh mc thuc gim c ban hnh km theo Q s 2032/1999/Q-BYT ngy 09/07/1999 Q s 3047/2001/Q-BYT ngy 12/07/2001 ca B trng B Y t v vic ban hnh quy ch qun l thuc hng tm thn, Danh mc thuc hng tm thn, tin cht dng lm thuc Q s 71/2004/Q-BYT ngy 09/01/2004 ca B trng B Y t v vic b sung mt s cht vo danh mc thuc hng tm thn. Tin cht dng lm thuc ca quy ch qun l thuc hng tm thn ban hnh theo Q s 3047/2001/Q-BYT ngy 12/07/2001 ca B trng B Y t CV s 1054/YT-TTr ngy 17/02/2005 ca B Y t v vic tng cng qun l thuc gy nghin, thuc hng tm thn. Q s 1895/1997/Q-BYT ngy 19/09/1997 ca B trng B Y t v vic ban hnh quy ch bnh vin (Quy ch chn on lm h s bnh n) Q s 1847/2003/Q-BYT ngy 28/5/2003 ca B trng B Y t v vic ban hnh quy ch k n v bn thuc theo n.

152